Provider Demographics
NPI:1801603253
Name:BENITEZ, LESLIE
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:BENITEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11241 SPEEGLE ST
Mailing Address - Street 2:
Mailing Address - City:CASTROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95012-2545
Mailing Address - Country:US
Mailing Address - Phone:831-484-3228
Mailing Address - Fax:
Practice Address - Street 1:11241 SPEEGLE ST
Practice Address - Street 2:
Practice Address - City:CASTROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95012-2545
Practice Address - Country:US
Practice Address - Phone:831-484-3228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst